Low T can impact both men and women, says noted physician Lauren Streicher, MD, but testosterone is not a panacea cure for sexual dysfunction or depression.

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Low T. It is a buzzword we hear all the time, in TV commercials and media. Low testosterone is said to be responsible for a number of maladies – including weight gain, depression, and low libido. We spoke with Lauren Striecher, MD, gynecologist, women’s health expert, and author of The Essential Guide to Hysterectomy (Taylor, 2012) about how low testosterone manifests and can be treated in both men and women.

Everyday Health: When a man is feeling a little depressed, sluggish, and worried about his sexual performance, should he be tested for low testosterone?

Dr. Streicher: It has become very trendy because there is an enormous campaign on behalf of the people who are making the testosterone to make every single guy feel like his problem is low T. It’s certainly worth measuring testosterone but, but it’s not the magic bullet. I am reminded of women who come to me and think if I give them estrogen all of their problems will be solved.

Yet some men do have low t issues?

I think certainly low testosterone is an issue for some men. My understanding is that men go down about one percent a year in terms of their testosterone level. And some men do get quite low so that it does make a difference in terms of their ability to not only sexually perform, but just their general sense of well being and energy. But I think that the picture is much bigger, just as it is for the women. But having said that, certainly we have men and women that are living longer and we do have this decline in testosterone overtime and I certainly think it is one of the parameters worth looking at in terms of looking at in terms of a guy’s overall health. But the idea that if you slap some testosterone gel on that everything is going to be great is over-simplifying it. Just as if you give a woman estrogen.

Since low t can contribute to lack of libido, don’t many people assume that it is also responsible for erectile dysfunction?

The absolute first cause of erectile dysfunction in this country is cardiovascular disease. It is not low T. And in fact if you have a guy who is performing just fine and then suddenly he’s not able to maintain an erection, before he runs off to get his testosterone checked, he better see what his coronary health is like because it is far more likely to be the culprit.

Can women be impacted by low testosterone, too?

Certainly. I do prescribe testosterone for women. However, when a woman goes through menopause and her estrogen levels take that huge decline, testosterone does not go down at the same time because testosterone is manufactured from a different part of the ovary then estrogen. In addition, the adrenal make testosterone. So there is a decline in testosterone levels but it doesn’t happen the same time as estrogen levels go down. The exception is the woman who has her ovaries removed. If someone has that surgical menopause then you are going to get that dive not only in estrogen, but in testosterone as well.

Testosterone fuels male desire, and can help women along too, but do women need as much testosterone as men for sexual function?

Testosterone levels in women don’t correlate very well with sexual interest. There have been a number of studies that have looked at that and, in fact, I have anecdotally and clinically found that to be true. I have some women who have very low testosterone levels and they are very highly sexually functioning; they have great libidos and they are very interested (in sex). I have other women that are practically shaving – and they couldn’t care less about sex. And I think that’s just another indicator that libido is complex and there are multiple factors that contribute to sexual desire. I do look at testosterone levels. While testosterone is one piece, that’s certainly not a whole story.

You mentioned there was a patch and there is a gel for women, but neither have been FDA approved, what do you prescribe for women who need little extra testosterone as they age?

When I prescribe testosterone for women, I use one of the FDA approved products that’s intended for men – one percent Androgel or Testim –or something like that. I play around with the dosage and I have found for a number of women, anecdotally, it does seem to make a difference. They feel very different with it than without it.

Any idea why some women may benefit and others not?

I find, as a sweeping generalization, the woman who is going to benefit from testosterone supplementation is the woman who comes in and says: “I had a great sex life. I love sex. I love my husband. And everything was fabulous… then I went through menopause and it’s like someone flipped the switch.” That’s the person for whom it very clearly is a lack of testosterone and if I give them a little testosterone they’re really going to notice the difference.

So testosterone will not create sexual benefits for all who seek it?

Most likely not for the woman who comes in and says, “I’m just not interested in sex and haven’t been for a long time. It started years before menopause and perimenopause.” Chances are there are so many factors going on there, because testosterone levels don’t go down that much during that time (menopause).

So we can’t rely on testosterone supplements to bring the sex drive and attraction back if it isn’t there to begin with?

Exactly. I always tell people I have a far more valuable way of measuring a testosterone level. When a woman comes in and says, “I have no interesting in having sex with my husband,” I’ll say, “Yeah, but do you fantasize about other people?” If she says “yes,” we may not need a blood level. A woman came to see me a few months ago and she had waited a long time for the appointment. She came from Illinois and she drove six hours to see me. And I sit down with her and start to talk to her about her medical history and her sexual history. We’re about halfway through and she turns to me and she says, “You know, I have to tell you something. I realized about half way between Southern Illinois and Chicago that I hate my husband. I hate him. And the only think I hate more than my husband is living in southern Illinois. So I don’t think I need you. I think I need a new life.” Libido is so complex – and everyone’s looking for the quick fix – but I do certainly prescribe testosterone for some women and in selective cases it does seem to make a difference.

Do you think men are having the same problem… that some men aren’t getting erections because they think their wives are unattractive?

Their penises are not so influenced by the fact that they’re not attracted to their wives. Certainly it’s a factor — if you can’t stand your wife and she’s not the object of your fantasies — but I don’t think that’s the big issue. I tell women, stop blaming yourself. If your husband isn’t interested or is not able to maintain is erection it is unlikely that it is because of you, if you have a reasonably good relationship. It could be other medications. It could be cardiovascular disease. Or it could be that his testosterone levels are low.

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